Behavioral research with head and neck squamous cell carcinoma (HNSCC) patients is high priority. The etiology of HNSCC is linked to the health risk behaviors of tobacco and alcohol consumption. At diagnosis, prevalence rates for cigarette smoking and alcohol use have been estimated to be above 80% and 65%, respectively. Among patients who report cigarette smoking in the year preceding diagnosis, about one-third continue to smoke following completion of cancer treatment. So while HNSCC diagnosis may be considered a "teachable moment," in which motivation for health behavior change is theorized to be high, not all patients regard HNSCC diagnosis as a sufficient catalyst for cigarette smoking cessation. Notably, this is despite the fact that continued cigarette smoking is associated with poor clinical outcomes, including poorer treatment response and higher risk for recurrence. Researchers have made attempts to identify variables associated with cigarette smoking after HNSCC diagnosis, but the current literature is limited. The overall objective of the proposed project is to increase understanding of factors facilitating and impeding smoking cessation among patients recently diagnosed with HNSCC. Specific aims: (1) To characterize the trajectory of cigarette smoking from the time of HNSCC diagnosis to 6 months following initiation of cancer treatment, (2) To assess the utility of Ajzen's Theory of Planned Behavior (TPB) for understanding changes in HNSCC patients'cigarette smoking, and (3) To assess the independent contribution of depressive symptoms and concurrent alcohol use for understanding changes in HNSCC patients'cigarette smoking. The above aims will be achieved using a prospective, longitudinal design in which 120 HNSCC patients are assessed before treatment initiation and then 2 and 6 months after treatment initiation. Males and females will be included in the study and the demographic characteristics of participants are expected to reflect the population of Kentucky. At each assessment, data will be collected via telephone interview. Study hypotheses will be tested using McNemar tests of paired comparisons, binomial logistic regression, and linear multiple regression analyses. Study results have the potential to highlight the importance of integrating discussions of behavior change into the course of cancer treatment, and may inform health personnel and behavioral science researchers of significant risk factors for cigarette smoking following HNSCC diagnosis. Results of the project may also be helpful in developing more efficacious smoking cessation interventions for HNSCC patients. PUBLIC HEALTH RELEVANCE: Overall, the proposed research is important because of its emphasis on understanding factors related to the reduction health risk behaviors, and associated improvement in clinical outcomes.